One goal of a technology-based health care system that fully integrates the technical and social aspects of patient care and therapy is to connect the client with care providers irrespective of separation distance or location of the participants. While clinicians will continue to treat patients in accordance with accepted medical practice, developments in communications technology are making it ever more possible to provide medical services in a time- and place-independent manner.
Past methods of clinical services are generally limited to in-hospital operations. For example, if a physician needs to review the performance parameters of an implantable device in a patient, the patient normally had to go to the clinic. Further, if the medical conditions of a patient with an implantable device warrant continuous monitoring or adjustment of the device, the patient would have to stay in a hospital indefinitely. Such a continued treatment plan poses both economic and social problems. Under this scenario, as the segment of the population with implanted medical devices increases many more hospitals/clinics and service personnel will be needed to provide in-hospital service for the patients, thus escalating the cost of healthcare. Additionally the patients will be unduly restricted and inconvenienced by the need to either stay in the hospital or make very frequent visits to a clinic.
Yet another condition of the past practice requires that a patient visit a clinical center for occasional retrieval of data from the implanted device to assess the operations of the device, gather patient history for both clinical and research purposes and adjust operational settings as needed. Such data is acquired by having the patient in a hospital/clinic to download the stored data from the implantable medical device. Depending on the frequency of data collection, this procedure may pose a serious difficulty and inconvenience for patients who live in rural areas or have limited mobility. Similarly, in the event a need arises to upgrade the software of an implantable medical device, the patient will be required to come into the clinic or hospital to have the upgrade installed.
Thus, there is a need to monitor the performance of the implantable devices on a regular, if not a continuous, basis to ensure optimal patient care. Further, there is a need to program an implantable device in response to such monitoring procedures to optimize the monitoring and therapy delivery functions of the implantable device. In the absence of other alternatives, this imposes a great burden on the patient if a hospital or clinic is the only center where the necessary frequent follow up, evaluation and programming of the medical devices could be made. Moreover, even if feasible, the situation would require the establishment of multiple service areas or clinic centers to provide adequate service to the burgeoning number of patients having implanted devices worldwide. Accordingly, it is vital to have a programmer unit that would connect to an expert medical center to provide access to expert systems and import the expertise to a local environment. This approach would enable unencumbered access to the implanted device or the patient.
To address these needs, a number of proposals have been made to enable remote programming and monitoring of an implantable medical device (IMD) from a centralized patient management system. Using modern communications technologies, data may be transferred from a centralized computer or server to a remote programmer located in the vicinity of a patient for transferring instructions received from the central location to the IMD.
With the inherent advantages of a remote patient management system, potential risks associated with remote IMD programming capabilities include inappropriate programming of an IMD or an adverse response to programming changes occurring when a patient is not under medical supervision. Retrieval of data from the IMD may occur on a scheduled basis, which is generally controlled by timers included in a home monitor or programmer and the IMD. While data may be acquired frequently or even continuously by the IMD, data regarding device performance or physiological conditions may only be transferred to a centralized patient management system during scheduled follow-up interrogation sessions.